The Impact of HIV Risk Reduction Behaviours on Sexually Transmissible Infections in HIV Negative Homosexual Men

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1 The Impact of HIV Risk Reduction Behaviours on Sexually Transmissible Infections in HIV egative Homosexual Men Fengyi Jin 1,2, Garrett P Prestage 1, David J Templeton 1,3, Basil Donovan 1,4, John Imrie 5, Susan C Kippax 5, Adrian Mindel 2, Anthony Cunningham 6, Philip Cunningham 7, John M Kaldor 1, Andrew E Grulich 1 1 CHECR; 2 STIRC; 3 RPA Sexual Health; 4 SSHC; 5 CHSR; 6 WMI; 7 CFI ew Zealand Sexual Health Society 31 st Annual Conference October 2009

2 Overview Methods The Health in Men (HIM) study Incident sexually transmissible infections (STIs) HIV risk reduction behaviours (RRB) Serosorting Strategic positioning Impact of RRB on STIs Compared with other means of UAI Compared with no UAI Adjustment for number of sexual partners and age

3 Background HIV risk reduction behaviours are common and increasingly practised in homosexual men They have been shown to be effective in lowering HIV risk in this population in some settings Little is known how they affect incidence of STIs

4 Methods HIM study Prospective cohort study of HIV negative homosexual men Community-based Recruitment & follow up to June 2007 Interview schedule Annual face-to-face interview Annual telephone Measurement of UAI: number of episodes By partner type (regular vs casual) By partners HIV status (negative, positive and status unknown) By sexual positioning (insertive vs receptive) Intra-anal ejaculation or not (in receptive UAI)

5 Incident STIs Syphilis EIA (ICE Murex) Confirmatory TPPA and/or FTA-Abs RPR assists clinical staging and reinfection Gonorrhoea and chlamydia (urethral and anal infections) AAT (BD ProbeTec) Positive anal G results confirmed by PorA Self-report of diagnoses since last interview Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) Serology (Focus Technologies) Anal and genital warts Self-report of diagnoses since last interview

6 RRB definition & analysis Serosorting = Reporting UAI with known/presumed HIV negative partners Regardless of sexual positioning / partner type Strategic positioning = Reporting only insertive UAI Regardless of partner type / partner s HIV status Serosorters were compared to those reporting: any serodiscordant UAI (HIV+ &/or status unknown partners) no UAI Strategic positioners were compared to those reporting: any receptive UAI no UAI

7 HIM demographics 1427 men recruited Median age: 35 (18-75) Retention rate: 87% (1 year); 81% (2 years) Median follow-up time: 3.9 years 95% gay or homosexual self-identified 53 HIV seroconversions during the study HIV incidence 0.78 per 100 person-years

8 Serosorting on bacterial STIs (compared with serodiscordant UAI = non-serosorting) HR 95% CI P value Syphilis Serosorting on-ss Urethral G <0.001 Serosorting on-ss Anal G Serosorting on-ss Urethral CT <0.001 Serosorting on-ss Anal CT <0.001 Serosorting on-ss

9 Serosorting on viral STIs (compared with serodiscordant UAI = non-serosorting) HR 95% CI P value HSV Serosorting on-ss HSV Serosorting on-ss Genital warts Serosorting on-ss Anal warts Serosorting on-ss

10 Serosorting vs non-serosorting (age and number of sexual partners adjusted) Adjust HR 95% CI P value Syphilis Serosorting on-ss Urethral G Serosorting on-ss Anal G Serosorting on-ss Urethral CT Serosorting on-ss Anal CT Serosorting on-ss

11 Serosorting on bacterial STIs (compared with no UAI) HR 95% CI P value Syphilis o UAI Serosorting Urethral G o UAI Serosorting Anal G o UAI Serosorting Urethral CT o UAI Serosorting Anal CT o UAI Serosorting

12 Serosorting on viral STIs (compared with no UAI) HR 95% CI P value HSV o UAI Serosorting HSV o UAI Serosorting Genital warts o UAI Serosorting Anal warts o UAI Serosorting

13 Serosorting vs no UAI (age and number of sexual partners adjusted) Adjust HR 95% CI P value Urethral CT <0.001 o UAI Serosorting Anal CT o UAI Serosorting HSV o UAI Serosorting

14 SP on bacterial STIs (compared with receptive UAI = R-UAI) HR 95% CI P value Syphilis SP R-UAI Urethral G SP R-UAI Anal G SP R-UAI Urethral CT SP R-UAI Anal CT SP R-UAI

15 SP on viral STIs (compared with receptive UAI = R-UAI) HR 95% CI P value HSV SP R-UAI HSV SP R-UAI Genital warts SP R-UAI Anal warts SP R-UAI

16 SP vs R-UAI (age and number of sexual partners adjusted) Adjust HR 95% CI P value Anal G SP R-UAI Anal CT <0.001 SP R-UAI

17 SP on bacterial STIs (compared with no UAI) HR 95% CI P value Syphilis o UAI SP Urethral G o UAI SP Anal G o UAI SP Urethral CT <0.001 o UAI SP Anal CT o UAI SP

18 SP on viral STIs (compared with no UAI) HR 95% CI P value HSV o UAI SP HSV o UAI SP Genital warts o UAI SP Anal warts o UAI SP

19 SP vs no UAI (age and number of sexual partners adjusted) Adjust HR 95% CI P value Urethral G o UAI SP Urethral CT <0.001 o UAI SP

20 Conclusion Compared with men who practised other means of UAI Serosorting risk of syphilis & urethral gonorrhoea Strategic positioning risk of anal gonorrhoea and anal chlamydia Compared with men who reported no UAI Serosorting risk of incident chlamydia Strategic positioning risk of urethral gonorrhoea and urethral chlamydia

21 Acknowledgements The authors thank all the HIM study participants, the HIM interview team and participating clinics for their contribution to this project. The ational Centre in HIV Epidemiology and Clinical Research and the ational Centre in HIV Social Research are funded by the Australian Government Department of Health and Ageing. The HIM project was funded by the Australian Government Department of Health and Ageing (Canberra), the ew South Wales Health Department (Sydney), the ational Institutes of Health, a component of the U.S. Department of Health and Human Services (IH/IAID/DAIDS: HVDDT Award 01-AI-05395), the ational Health and Medical Research Council (#400944). Testing for syphilis was funded by SW health. Testing materials for gonorrhoea and chlamydia were provided by Becton Dickinson. Confirmatory PorA tests were performed by Leon Mcally at SydPath. HSV testing was funded by GlaxoSmithKline.